Com-pound it!

compound drug advertisementWe’ve heard a lot about compounding drugs in the world of workers’ comp. But what is all the fuss about? They are scary because they are not tightly regulated and they are driving up costs for the industry. In the report, “Compounding is Confounding Workers’ Compensation” from CompPharma, the authors question whether compound drugs are more effective than commercially available drugs (they say no), they wonder if they are really necessary most of the time they are prescribed (they say no), they wonder if they are even more cost effective (you guessed it- no).

Compound prescriptions have been on the rise in recent years, this report cited data from a 2007 study that found compound prescriptions increased from 6,416 in 2007 to a startling 30,669 by 2012. The latest Drug Report from Express Scripts gave the example that the cost for a prescription of the compound diclofenac ran $770 in 2013, compared to $46 for the commercial alternative. Topical compounds (applied directly to the skin) and sterile compounds (which require a sterile method of delivery like through a needle) are the two biggies in work comp. Recently, producers have been able to market directly to doctors for their products. The problem is that a lot of their formulations are not always FDA approved and do not have to submit to drug trials or provide solid evidence to back up their marketing messages.

These medications are good for some patients. Those who may not be able to take the traditional form of medication (think pill vs liquid form), or those who are allergic to some ingredient in the manufactured version (rare but possible). However, now that compounders have begun to market their wares to physicians, they might use them treat more patients who don’t necessarily need these compounds. There is not a requirement to track or report the patients who may have less-than-stellar results with these compounds either so we don’t even know the full effects.

A scary thing about these mass produced compounds is that they don’t always get their measurements right or they are not as sterile as they claim to be. The report points to the meningitis outbreak that resulted after compounded steroids that had been contaminated were sent out and used in real patients. Over 50 people died and hundreds more contracted infections. While this incident may spur new regulations and stricter testing for compound drugs in the future, that doesn’t help those who were affected from drugs that lacked serious regulation before they went out.

Some states are starting to take action by billing more for compound drugs or by charging for drugs by the ingredient. Results from these initiatives are mixed, so far, as they are relatively new and it seems too early to tell how effective the regulations are.

The authors of the study concluded that compound drugs will continue to be used for those patients who might not have any other treatment option but regulations may be coming soon that would curb their use for other patients. They point out that after pharmacists were able to market directly to doctors, the money got in the way of the real medical diagnosis and prescriptions skyrocketed. These prescriptions are sort of loosely regulated by states but now that regulation might shift more to the FDA which could either drive up costs more or maybe just remove that as a viable treatment option unless patients really needed them.

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